Thursday, February 22, 2007

There are two issues I have been grappling with in deciding to start a family. So today I'll tackle the first one -- should someone who is bipolar have kids.

This is a very complicated and personal decision and also one that lots of people like to weigh in on. Countless people in depression and bipolar support groups and on various message boards have said they can't ever imagine bringing a child into the world who may inherit a mental illness. And for a while I too thought the same thing. But over the last few years as my illness stabilized my opinion changed.

So here are my answers to the questions my people have asked:

1. Aren't you worried that your child will be bipolar?I'm really not that concerned for several reasons. Although bipolar disorder does have a strong genetic risk -- according to many doctors and scientists the risk of passing the disease is 10%. Some geneticists say it may be as high as 15%. Many people with the disorder exaggerate the number and are concerned that it is around 50%. It isn't

To put it in perspective - The risk really isn't that large. Currently 31% of Americans are obese. So statistically speaking my child will have a more than three times the of risk of developing obesity. Obesity greatly increases the risk of other serious medical conditions including diabetes which is the 6th leading cause of death in this country. Obesity also increases the risk of cancer, heart attacks and strokes.

I beleive in 15 years the advances of science will make living with bipolar a non-issue. Doctors and scientists are greatly expanding their understanding of how the brain works and how it misfunctions.

Only 13 years ago there was one medication approved for bipolar (lithum). Just 10 year ago there were only two medications (lithium and depakote). Now there are more choices and better treatments. Currently the following are approved for different phases of bipolar: Lithium, Depakote, Lamictal, Symbyax, Seroquel, Risperdal, Geodon, Abilify and Equetro (extended release version of Tegretol). And many more drugs are used "off-label." If so much has changed in the last 15 years, what do you think will happen in the next?

Aren't you concerned you will get depressed or manic while pregnant?I realize that going off meds is a risk. However, I have full faith that if something happens my doctor will be able to get me back on track. I believe that eating right, exercising, maintatining a regular sleep schedule and keeping stress levels in check will affect my ability to stay well. I also don't intend to stay off my meds for the entire pregnancy.

Aren't you worried that the medication could be bad for a developing fetus?I've read the studies, poured over the data from the pregnancy registries and I think that my medication (Lamictal) is actually fairly safe. So far the statisics show a 2.9% incidence of major birth defects. The baseline rate for the general population is 3%. Which means that if the data is correct -- you do not have a greater chance of birth defects than someone who is not on meds. I've also decided to go back on medicine the second trimester. Although at a lower dose than I was on before.

Here's a recent article about the mental health risks after pregnancy:

Major study finds issues go beyond postpartum depressionNew moms face increased risks for a variety of mental problems, not just postpartum depression, according to one of the largest studies of psychiatric illness after childbirth.

New dads aren’t as vulnerable, probably because they don’t experience the same physical and social changes associated with having a baby, the researchers and other experts said.

The study, based on medical records of 2.3 million people over a 30-year period in Denmark, found that the first three months after women have their first baby is riskiest, especially the first few weeks. That’s when the tremendous responsibility of caring for a newborn hits home.

During the first 10 to 19 days, new mothers were seven times more likely to be hospitalized with some form of mental illness than women with older infants. Compared to women with no children, new mothers were four times more likely to be hospitalized with mental problems.

Tuesday, February 20, 2007

An interesting article I just came across about anticonvulsants (many of which are used for bipolar disorder):

In the general population, when a woman takes a daily multivitamin tablet with folic acid just before and at conception, her risk of having a child with spina bifida and other birth defects is decreased. However, for women taking AEDs, it is not yet clear if taking a daily multivitamin with folic acid will decrease their risk of having a baby with a birth defect. One concern is that some anticonvulsant drugs, like phenytoin (Dilantin®) and carbamazepine (Tegretol®) are folic acid antagonists, meaning that they counteract the effects of folic acid supplements. But, some other AEDs, like lamotrigine (Lamictal®) are not folic acid antagonists.

Very few research studies have addressed this issue. In one study, researchers at Boston University showed that folic acid supplements did not affect the risk for heart defects, oral clefts or urinary tract anomalies in children born to mothers taking some AEDs. However, in that same study these researchers found that taking a folic acid supplement decreased the risk for spina bifida in infants born to women taking carbamazepine (Tegretol®).

The book was done in a Q&A format which allowed for quick reading -- and allows you to easily just read the things you are interested in. One of the things I liked is he discussed the actual studies -- and dispelled the hype. The bottom line -- there is no reason to live in a bubble just because you are pregnant. You can still drink coffee, exercise intensely and do weight training, and you can take many medicines like pain killers and other prescription drugs. And you can keep your cats! I've had numerous friends tell me that I may need to get rid of my cats while I'm pregnant -- it's a complete overreaction to the risk of Toxoplasmosis.

Information on effects of psychiatric drugs in pregnancy is very limited. This is because drugs are not tested on pregnant women. It would be seen as unethical to use pregnant women as guinea pigs. What is known about the effects of drugs in pregnancy comes almost entirely from anecdotal reports and clinical experience documented in various pregnancy registries.

Many medications have registries set up to collect data. Some registries require health care providers to do the enrollment while others allow the patient to enroll.

It's important if you do decide to take medicine during pregnancy to register with the registries. The results from these pregnancy registries help answer the common question "Is this medicine safe for my baby?"

Here are links to various registries for drugs used for bipolar disorder:

Saturday, February 17, 2007

The decision to start a family can be a nerve-wracking time for many women. I think it is even more so for someone who is diagnosed with a condition like bipolar disorder.

Instead of just fretting about if it is safe to drink caffeine or take Advil (like many of my friends) -- I am also faced with deciding if I should remain on my medication while pregnant. Is it better to stay on my meds to ensure more mood stability or should I forgo medication because it might affect the baby? Am I more likely to become manic or depressed during pregnancy? How will I deal with sleep? Will a lack of sleep throw me into mania?

And of course there is the struggle with the bigger question of is it right to bring a child into the world when there is the chance they could inherit this condition.

I've spent countless hours searching the internet and reading books -- and although there is a ton of information about pregnancy and tons of information about bipolar disorder. There is very little information about managing bipolar during pregnancy. So my mission is to have a place where I can share all the information I find in one central place.